Yang N.-P.,National Yang Ming University |
Chen H.-C.,National Yang Ming University |
Phan D.-V.,Yuan Ze University |
Yu I.-L.,Tao Yuan General Hospital |
And 5 more authors.
BMC Musculoskeletal Disorders | Year: 2011
Background: The epidemiology of acute orthopedic dislocations is poorly understood. A nationwide database provides a valuable resource for examining this issue in the Taiwanese population. Methods. A 6-year retrospective cohort study of 1,000,000 randomly-sampled beneficiaries from the year 2005 was used as the original population. Based on the hospitalized and ambulatory data, the concomitant ICD9-CM diagnosis codes and treatment codes were evaluated and classified into 8 and 3 major categories, respectively. The cases matching both inclusive criteria of dislocation-related diagnosis codes and treatment codes were defined as incident cases. Results: During 2000-2005, the estimated annual incidence (per 100,000 population) of total orthopedic dislocations in Taiwan was 42.1 (95%CI: 38.1-46.1). The major cause of these orthopedic dislocations was traffic accidents (57.4%), followed by accident falls (27.5%). The annual incidence dislocation by location was shoulder, 15.3; elbow, 7.7; wrist, 3.5; finger, 4.6; hip, 5.2; knee, 1.4; ankle, 2.0; and foot, 2.4. Approximately 16% of shoulder dislocations occurred with other concomitant fractures, compared with 17%, 53%, 16%, 76% and 52%, respectively, of dislocated elbow, wrist, hip, knee, and ankle cases. Including both simple and complex dislocated cases, the mean medical cost was US$612 for treatment of a shoulder dislocation, $504 for the elbow, $1,232 for the wrist, $1,103 for the hip, $1,888 for the knee, and $1,248 for the ankle. Conclusions: In Taiwan, three-quarters of all orthopedic dislocations were of the upper limbs. The most common complex fracture-dislocation was of the knee, followed by the wrist and the ankle. Those usually needed a treatment combined with open reduction of fractures and resulted in a higher direct medical expenditure. © 2011 Yang et al; licensee BioMed Central Ltd.
Wu Y.-K.,Buddhist Tzu Chi General Hospital |
Wu Y.-K.,Tzu Chi University |
Tsai Y.-H.,Chang Gung Memorial Hospital |
Tsai Y.-H.,Chang Gang University |
And 5 more authors.
Critical Care | Year: 2010
Introduction: Mechanical ventilation of patients may be accomplished by either translaryngeal intubation or tracheostomy. Although numerous intensive care unit (ICU) studies have compared various outcomes between the two techniques, no definitive consensus indicates that tracheostomy is superior. Comparable studies have not been performed in a respiratory care center (RCC) setting.Methods: This was a retrospective observational study of 985 tracheostomy and 227 translaryngeal intubated patients who received treatment in a 24-bed RCC between November 1999 and December 2005. Treatment and mortality outcomes were compared between tracheostomized and translaryngeal intubated patients, and the factors associated with positive outcomes in all patients were determined.Results: Duration of RCC (22 vs. 14 days) and total hospital stay (82 vs. 64 days) and total mechanical ventilation days (53 vs. 41 days) were significantly longer in tracheostomized patients (all P < 0.05). The rate of in-hospital mortality was significantly higher in the translaryngeal group (45% vs. 31%;P < 0.05). No significant differences were found in weaning success between the groups (both were >55%) or in RCC mortality. Because of significant baseline between-group heterogeneity, case-match analysis was performed. This analysis confirmed the whole cohort findings, except for the fact that a trend for in-hospital mortality was noted to be higher in the translaryngeal group (P = 0.08). Stepwise logistic regression revealed that patients with a lower median severity of disease (APACHE II score <18) who were properly nourished (albumin >2.5 g/dl) or had normal metabolism (BUN <40 mg/dl) were more likely to be successfully weaned and survive (all P < 0.05). Patients who were tracheostomized were also significantly more likely to survive (P < 0.05). Conclusions: These findings suggest that the type of mechanical ventilation does not appear to be an important determinant of weaning success in an RCC setting. Focused care administered by experienced providers may be more important for facilitating weaning success than the ventilation method used. However, our findings do suggest that tracheostomy may increase the likelihood of patient survival. © 2010 Wu et al.; licensee BioMed Central Ltd.
Chen L.-P.,National Taiwan University Hospital |
Chen L.-P.,Chang Gang University |
Hsu S.-P.,National Taiwan University Hospital |
Peng Y.-S.,National Taiwan University Hospital |
And 2 more authors.
Nephrology Dialysis Transplantation | Year: 2011
Background. Periodontitis and metabolic syndrome are highly prevalent in hemodialysis (HD) patients but little information is available on their association. Thus, this study aimed to assess the association between these two conditions in a HD cohort. Methods. Data from 253 HD patients were analyzed. The association of periodontitis, gingival inflammation and dental plaque burden with metabolic syndrome and its individual component conditions were evaluated. Adjustments for age, gender, socioeconomic status, comorbidity and smoking status were considered. Results. The prevalence of metabolic syndrome was 65.1% among individuals (n = 149) with moderate-severe periodontitis, 54.5% among individuals (n = 55) with mild periodontitis and 36.7% among individuals (n = 49) without periodontitis. After adjustment of confounders, patients with moderate-severe periodontitis were 2.736 [95% confidence interval (CI), 1.293-5.790] times more likely to develop metabolic syndrome than were those without periodontitis. In addition, the odds ratio for metabolic syndrome was 1.561 (95% CI, 1.121-2.166) per score of gingival inflammation severity and 1.724 (95% CI, 1.135-12.615) per score of dental plaque burden. Conclusions. Moderate-severe periodontitis is associated with metabolic syndrome in HD patients. Whether improved oral health reduces the risk of metabolic syndrome is worth determining through further studies. © 2011 The Author.
Nan-Ping Y.,National Yang Ming University |
Nan-Ping Y.,National Taiwan University |
Yi-Hui L.,National Taiwan University |
Yi-Hui L.,Chang Gang University |
And 5 more authors.
BMC Health Services Research | Year: 2013
Background: In Taiwan, the policy of catastrophic illness certificates has benefited some populations with specific diseases, but its effect on the use of medical services and the sequence of public health has not been examined. As a pilot of a series of studies, focused on emergency department (ED) visits, the present study aimed to compare medical utilization and various diagnostic categories at EDs between the elderly with an identified catastrophic illness and the elderly without. Methods. A cross-sectional study, based on a large-sample nationwide database (one million of the population, randomly sampled from Taiwan's National Health Insurance Research Database (NHIRD)), was performed in Taiwan. The 2008 insurance records of ambulatory medical services for subjects aged 65 years or more among the above one million of the population were further selected and analyzed. Taiwan's registered catastrophic illness dataset for 2008 was linked in order to identify the target subgroup. Results: The prevalence of certificated catastrophic illness in Taiwan's elderly utilizing ambulatory medical services was 10.16%. On average, 61.62 emergency department (ED) visits/1,000 persons (95% CI: 59.22-64.01) per month was estimated for the elderly Taiwanese with catastrophic illness, which was significantly greater than that for the elderly without a catastrophic illness (mean 33.53, 95% CI: 32.34-34.71). A significantly greater total medical expenditure for emergency care was observed in the catastrophic illness subgroup (US$145.6 ± 193.5) as compared with the non-catastrophic illness group (US$108.7 ± 338.0) (p < 0.001). The three most common medical problems diagnosed when visiting EDs were injury/poisoning (14.22%), genitourinary disorders (11.26%) and neoplasm-related morbidity (10.77%) for the elderly population with a catastrophic illness, which differed from those for the elderly without a catastrophic illness. Conclusions: In Taiwan, the elderly with any certificated catastrophic illness had significantly more ED visits and a higher ED medical cost due to untypical medical complaints. © 2013 Nan-Ping et al.; licensee BioMed Central Ltd.
Chang N.-T.,National Yang Ming University |
Chang N.-T.,National Taiwan University |
Lee Y.-H.,National Taiwan University |
Lee Y.-H.,Chang Gang University |
And 5 more authors.
Clinical Interventions in Aging | Year: 2013
Background: The burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors. Methods: A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004-2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury. Results: A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum ($65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10-3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures. Conclusion: The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis. © 2013 Chang et al, publisher and licensee Dove Medical Press Ltd.